Provider Demographics
NPI:1356412951
Name:KOHL, GWYNNE ODETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:GWYNNE
Middle Name:ODETTE
Last Name:KOHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6869 WOODLAWN AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5469
Mailing Address - Country:US
Mailing Address - Phone:206-550-1998
Mailing Address - Fax:
Practice Address - Street 1:6869 WOODLAWN AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5469
Practice Address - Country:US
Practice Address - Phone:206-550-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSYC.PY60399151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11852OtherAUTHORITY TO PRACTICE TELEPSYCHOLOGY (APIT) E. PASSPORT